scholarly journals Preeclampsia and Cardiovascular Disease in a Large UK Pregnancy Cohort of Linked Electronic Health Records

Circulation ◽  
2019 ◽  
Vol 140 (13) ◽  
pp. 1050-1060 ◽  
Author(s):  
Lydia J. Leon ◽  
Fergus P. McCarthy ◽  
Kenan Direk ◽  
Arturo Gonzalez-Izquierdo ◽  
David Prieto-Merino ◽  
...  
Keyword(s):  
Electronic Health Records ◽  
Cumulative Incidence ◽  
Chronic Hypertension ◽  
Cardiovascular Disorders ◽  
Hypertensive Disorders Of Pregnancy ◽  
Health Records ◽  
Hypertensive Disorders ◽  
Increased Risk ◽  
Electronic Health ◽  
The Impact

Background: The associations between pregnancy hypertensive disorders and common cardiovascular disorders have not been investigated at scale in a contemporaneous population. We aimed to investigate the association between preeclampsia, hypertensive disorders of pregnancy, and subsequent diagnosis of 12 different cardiovascular disorders. Methods: We used linked electronic health records from 1997 to 2016 to recreate a UK population-based cohort of 1.3 million women, mean age at delivery 28 years, with nearly 1.9 million completed pregnancies. We used multivariable Cox models to determine the associations between hypertensive disorders of pregnancy, and preeclampsia alone (term and preterm), with 12 cardiovascular disorders in addition to chronic hypertension. We estimated the cumulative incidence of a composite end point of any cardiovascular disorder according to preeclampsia exposure. Results: During the 20-year study period, 18 624 incident cardiovascular disorders were observed, 65% of which had occurred in women under 40 years. Compared to women without hypertension in pregnancy, women who had 1 or more pregnancies affected by preeclampsia had a hazard ratio of 1.9 (95% confidence interval 1.53–2.35) for any stroke, 1.67 (1.54–1.81) for cardiac atherosclerotic events, 1.82 (1.34–2.46) for peripheral events, 2.13 (1.64–2.76) for heart failure, 1.73 (1.38–2.16) for atrial fibrillation, 2.12 (1.49–2.99) for cardiovascular deaths, and 4.47 (4.32–4.62) for chronic hypertension. Differences in cumulative incidence curves, according to preeclampsia status, were apparent within 1 year of the first index pregnancy. Similar patterns of association were observed for hypertensive disorders of pregnancy, while preterm preeclampsia conferred slightly further elevated risks. Conclusions: Hypertensive disorders of pregnancy, including preeclampsia, have a similar pattern of increased risk across all 12 cardiovascular disorders and chronic hypertension, and the impact was evident soon after pregnancy. Hypertensive disorders of pregnancy should be considered as a natural screening tool for cardiovascular events, enabling cardiovascular risk prevention through national initiatives.

scholarly journals Hypertensive disorders of pregnancy and risk of neurodevelopmental disorders in the offspring: a systematic review and meta-analysis protocol

BMJ Open ◽  
2017 ◽  
Vol 7 (10) ◽  
pp. e018313 ◽  
Author(s):  
Gillian M Maher ◽  
Gerard W O’Keeffe ◽  
Louise C Kenny ◽  
Patricia M Kearney ◽  
Ted G Dinan ◽  
...  
Keyword(s):  
Systematic Review ◽  
Neurodevelopmental Disorders ◽  
Meta Analysis ◽  
Autism Spectrum ◽  
Chronic Hypertension ◽  
Hypertensive Disorders Of Pregnancy ◽  
Hypertensive Disorders ◽  
Increased Risk ◽  
Meta Analyses ◽  
The Impact

IntroductionHypertensive disorders of pregnancy (HDPs), that is chronic hypertension, gestational hypertension, pre-eclampsia (de novo or superimposed on chronic hypertension) and white coat hypertension, affect approximately 5%–15% of pregnancies. HDP exposure has been linked to an increased risk of autism spectrum disorder, attention deficit/hyperactivity disorder and other neurodevelopmental disorders in children. However, findings are inconsistent, and a clear consensus on the impact of HDPs on the risk of neurodevelopmental disorders is needed. Therefore, we aim to synthesise the published literature on the relationship between HDPs and the risk of neurodevelopmental disorders in the form of a systematic review and meta-analysis.Methods and analysisWe will include cohort, case–control and cross-sectional studies in which diagnosis of an HDP was reported, and neurodevelopmental disorders were the outcome of interest based on a preprepared protocol. A systematic search of PubMed, CINAHL, Embase, PsycINFO and Web of Science will be conducted in accordance with a detailed search strategy. Two authors will independently review the titles and abstracts of all studies, perform data extraction using a standardised data collection form and assess study quality using a bias classification tool. Meta-analyses will be performed to calculate overall pooled estimates using the generic inverse variance method. This systematic review will be reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses.Ethics and disseminationThis proposed systematic review and meta-analysis is based on published data, therefore, does not require ethics approval. Findings will be presented at scientific conferences and disseminated through publication in a peer-reviewed journal.RegistrationCRD42017068258.

scholarly journals The impact of electronic health records on healthcare quality: a systematic review and meta-analysis

2015 ◽  
Vol 26 (1) ◽  
pp. 60-64 ◽  
Author(s):  
Paolo Campanella ◽  
Emanuela Lovato ◽  
Claudio Marone ◽  
Lucia Fallacara ◽  
Agostino Mancuso ◽  
...  
Keyword(s):  
Systematic Review ◽  
Electronic Health Records ◽  
Meta Analysis ◽  
Healthcare Quality ◽  
Health Records ◽  
Electronic Health ◽  
The Impact

The Promise of Electronic Health Records to Promote Shared Decision Making: A Narrative Review and a Look Ahead

2018 ◽  
Vol 38 (8) ◽  
pp. 1040-1045 ◽  
Author(s):  
Alyce Mei-Shiuan Kuo ◽  
Berry Thavalathil ◽  
Glyn Elwyn ◽  
Zsuzsanna Nemeth ◽  
Stuti Dang
Keyword(s):  
Decision Making ◽  
Electronic Health Records ◽  
Shared Decision Making ◽  
Decisional Conflict ◽  
Shared Decision ◽  
Health Records ◽  
Look Ahead ◽  
The Face ◽  
Electronic Health ◽  
The Impact

Background. Shared decision making (SDM) involves the sharing of best available evidence between patients and providers in the face of difficult decisions. We examine outcomes that occur when electronic health records (EHRs) are purposefully used with the goal of improving SDM and detail which EHR functions can benefit SDM. Methods. A systematic search of PubMed yielded 1369 articles. Studies were included only if they used EHR interventions to support SDM and included results that showed impact on SDM. Articles were excluded if they did not measure the impact of the intervention on SDM or did not discuss how SDM had been supported by the EHR. Results. Five studies demonstrated improved clinical outcomes, positive lifestyle behavior changes, more deliberation from patients regarding use of imaging, and less decisional conflict about medication use among patients with use of EHRs aiding SDM. Discussion. Few EHRs have integrated SDM, and even fewer evaluations of these exist. EHRs have potential in supporting providers during all steps of SDM. The promise of EHRs to support SDM has yet to be fully exploited.

Association Between Meaningful Use and Florida Counties’ COVID-19 Case and Death Rates Among Medicaid Providers (Preprint)

2021 ◽  
Author(s):  
Katherine Freeman ◽  
Judith P. Monestime
Keyword(s):  
Electronic Health Records ◽  
Cumulative Incidence ◽  
Meaningful Use ◽  
County Level ◽  
Cross Sectional ◽  
Health Records ◽  
Death Rates ◽  
Public Health Reporting ◽  
Electronic Health ◽  
Population Demographic

BACKGROUND Although the Health Information Technology for Economic and Clinical Health (HITECH) Act has accelerated the adoption of Meaningful Use of Electronic Health Records (EHRs) among Medicaid providers, only about half achieve Meaningful Use. Furthermore, the validity of public health reporting of COVID-19 outcomes, which relies on Meaningful Use advanced functions, remains unknown. OBJECTIVE This study aims to examine the difference between Medicaid providers who did and did not achieve Meaningful Use regarding Florida county-level incidence rates of COVID-19 cases and deaths, accounting for county-level race/ethnicity, unemployment, income, prevalence of respiratory diseases, age, poverty, and healthcare environment. METHODS This cross-sectional ecologic study examined the association between Meaningful Use achievement by Medicaid providers and COVID-19 cases and death rates from 67 Florida counties as of November 19, 2020. Provider information was obtained from the publicly available database from the Florida Medicaid Promoting Interoperability Program, formerly Electronic Health Record Incentive Program. The database includes the Area Health Resources File, capturing provider characteristics and population demographic and socioeconomic characteristics at the county level. Cumulative COVID-19 cases and deaths were obtained from the Florida Department of Health Open Data (FDOH) for zip codes which were aggregated by county. Rates were obtained by dividing cumulative incidence or prevalence by the U.S. Census County population. RESULTS As of November 19, 2020, the cumulative incidence rate of COVID-19 deaths was significantly different between Medicaid providers who achieved Meaningful Use and those who did not (P=.0131), with relatively more deaths reported for those not achieving Meaningful Use. County-level characteristics associated with increased COVID-19 death rates in hierarchical models include greater concentrations of persons of African American or Black race (P<.0001), lower median household income (P<.0001), higher unemployment (P<.0001), and higher concentrations of those living in poverty (P<.0001) and without health insurance (P<.0001). CONCLUSIONS Although Federal subsidies successfully influenced the adoption of Electronic Health Records, our findings suggest an emerging further digital "advanced use" divide among patients cared for by Medicaid providers. Policy interventions need to be reevaluated to address disparities in COVID-19 clinical outcomes which appear exacerbated by the limited use of advanced Electronic Health Records functions. CLINICALTRIAL not applicable

The Impact of the Global, Extensible Electronic Health Record

2011 ◽  
pp. 3-13 ◽  
Author(s):  
David W. Forslund ◽  
David G. Kilman
Keyword(s):  
Electronic Health Records ◽  
Negative Impact ◽  
Global Scale ◽  
Global Perspective ◽  
Health Records ◽  
Technological Advances ◽  
The World ◽  
Electronic Health ◽  
The Impact

With the arrival of the “World Wide Web,” we have witnessed a transition toward a truly global perspective with respect to electronic health records. In recent years, much more discussion has focused on the potential for international virtual electronic health records and what is required for them to become a reality in the world today (Kilman & Forslund, 1997). As the Internet becomes more ubiquitous and Web-enabled, we see access to electronic health records using these technologies becoming more commonplace. Even so, these Web-enabled health records still remain technologically isolated from other medical records in the distributed continuum of care; much of the standardization challenge still stands before us. We have witnessed startling technological advances, but we still face considerable obstacles to the goal of having globally standardized electronic health records. In this chapter we describe some of the issues associated with Web-enabled health records, the role of standards in the evolution of Web-enabled health records, and some of the barriers to the development of globally accessible electronic health records. We discuss possible ways to overcome these barriers and the kinds of benefits and opportunities that global health records will help provide. The global scale perspective makes more evident the very real and potentially tragic consequences of prolonged and unnecessary delays in deploying these technologies. Therefore, in an effort to promote a fuller consciousness of health safety, the chapter concludes with a comparative look at the negative impact of impediments in the movement toward global extensible electronic health records.

scholarly journals The Impact of Electronic Health Records on Ambulatory Costs Among Medicaid Beneficiaries

2013 ◽  
Vol 3 (2) ◽  
pp. E1-E16
Author(s):  
Julia Adler-Milstein ◽  
Claudia Salzberg ◽  
Calvin Franz ◽  
E. Orav ◽  
David Bates
Keyword(s):  
Electronic Health Records ◽  
Health Records ◽  
Medicaid Beneficiaries ◽  
Electronic Health ◽  
The Impact
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